Abstract
Imaging changes in left ventricular (LV) volumes during the cardiac cycle and LV ejection fraction do not provide information on regional contractility. Displacement ENcoding with Stimulated Echoes (DENSE) is a strain-encoded cardiac magnetic resonance (CMR) technique that measures strain directly. We investigated the relationships between strain revealed by DENSE and the presence and extent of infarction in patients with recent myocardial infarction (MI). 50 male subjects were invited to undergo serial CMR within 7 days of MI (baseline) and after 6 months (follow-up; n = 47). DENSE and late gadolinium enhancement (LGE) images were acquired to enable localised regional quantification of peak circumferential strain (Ecc) and the extent of infarction, respectively. We assessed: (1) receiver operating characteristic (ROC) analysis for the classification of LGE, (2) strain differences according to LGE status (remote, adjacent, infarcted) and (3) changes in strain revealed between baseline and follow-up. 300 and 258 myocardial segments were available for analysis at baseline and follow-up respectively. LGE was present in 130/300 (43 %) and 97/258 (38 %) segments, respectively. ROC analysis revealed moderately high values for peak Ecc at baseline [threshold 12.8 %; area-under-curve (AUC) 0.88, sensitivity 84 %, specificity 78 %] and at follow-up (threshold 15.8 %; AUC 0.76, sensitivity 85 %, specificity 64 %). Differences were observed between remote, adjacent and infarcted segments. Between baseline and follow-up, increases in peak Ecc were observed in infarcted segments (median difference of 5.6 %) and in adjacent segments (1.5 %). Peak Ecc at baseline was indicative of the change in LGE status between baseline and follow-up. Strain-encoded CMR with DENSE has the potential to provide clinically useful information on contractility and its recovery over time in patients with MI.
Highlights
Regional left ventricular (LV) systolic function has prognostic importance in survivors of myocardial infarction (MI) [1, 2]
We investigated the relationships between strain revealed by Displacement ENcoding with Stimulated Echoes (DENSE) and the presence and extent of infarction in patients with recent myocardial infarction (MI). 50 male subjects were invited to undergo serial cardiac magnetic resonance (CMR) within 7 days of MI and after 6 months
We assessed: (1) receiver operating characteristic (ROC) analysis for the classification of late gadolinium enhancement (LGE), (2) strain differences according to LGE status and (3) changes in strain revealed between baseline and follow-up. 300 and 258 myocardial segments were available for analysis at baseline and follow-up respectively
Summary
Regional left ventricular (LV) systolic function has prognostic importance in survivors of myocardial infarction (MI) [1, 2]. Imaging of LV wall motion is an indirect method for assessing contractility, and cardiac magnetic resonance (CMR) can provide information on LV contractility using strain-specific techniques. Measurement of strain rather than LV motion should theoretically increase the diagnostic accuracy and prognostic value of cardiac imaging in patients with a history of MI [3]. The fact that CMR provides quantitative information on infarct pathology as well as myocardial strain makes this imaging modality attractive for clinical and research purposes in patients with a history of MI. The heart moves through and rotates within a given imaging plane. The relationship between the apparent motion of the endocardial and
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